Asphyxia in the New-Born, is Hypothermia Enough?

Neonatal hypoxic-ischemic encephalopathy (HIE) following birth asphyxia (hypoxic-ischemic insult) is still a major cause of mortality and/or long-term morbidity in term neonates. The incidence varies with 1-4 per 1000 live births in the high-income countries to as high as 26 per 1000 live births in the low-income countries, thus asphyxia affects 1 million infants every year worldwide and accounts for about 30% of neonatal deaths worldwide.

Hypothermia was introduced in the 1990 as potential protection of the brain after in infants suffering from asphyxia. In 2005-2006 several large RC trials were conducted to show beneficial effect of hypothermia which has become standard care to improve outcome after perinatal hypoxic-ischemic insults. Despite hypothermia and modern supportive neonatal intensive care, 45-50% of children with moderate or severe HIE still die or suffer from long-term neurodevelopmental impairment. In it has been demonstrated that the number of children who would need to be treated with hypothermia in order to prevent 1 child from dying or having an IQ score lower than 85 was 8. Therefore, additional early neuroprotective interventions, besides hypothermia, are warranted to further improve their outcome.

Thus, several drugs with the potential of being brain protective has been suggested as an added therapy in addition to hypothermia, among these are: Stem-cell therapy, allopurinol, melatonin, erythropoietin